Our Lady's Hospice and Care Services, Dublin 6w, Ireland.
BMC Palliat Care. 2012 Mar 1;11:3. doi: 10.1186/1472-684X-11-3.
The results of a small number of studies of autonomic function in patients with advanced cancer suggest that autonomic dysfunction (AD) is common. In other disease-specific groups this is associated with decreased survival, falls and symptoms such as postural hypotension, nausea, early satiety and fatigue. The contribution of AD to symptoms in advanced cancer is unknown.
We conducted a prospective cohort study designed to identify the risk factors for falls in patients with advanced cancer. Ambulant adult patients admitted consecutively to palliative care services were invited to participate. Participants underwent an assessment at baseline which included standard clinical tests of autonomic function, assessment of symptom severity, muscle strength, anthropometric measurements, walking speed, medication use, comorbidities and demographics. Information regarding survival was recorded ten months following cessation of recruitment. The clinical correlates of AD, defined as definite or severe dysfunction using Ewing's classification, were examined by univariate and multivariate logistic regression analysis. Survival analysis was conducted using Kaplan-Meier plots and the log rank test.
Of 185 patients recruited, 45% were unable to complete all of the clinical tests of autonomic function. Non-completion was associated with scoring high on clinical indicators of frailty. It was possible to accurately classify 138/185 (74.6%) of participants as having either definite or severe versus normal, early or atypical AD: 110 (80%) had definite/severe AD. In logistic regression analysis, age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and increased severity of fatigue (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were associated with having definite/severe AD. In analysis adjusted for age, median survival of participants with definite/severe AD was shorter than in those with normal/early/atypical classification (χ2 = 4.3, p = 0.038).
Autonomic dysfunction is highly prevalent in patients with advanced cancer and is associated with increased severity of fatigue and reduced survival. Due to frailty, up to 45% of participants were unable to complete standard clinical tests of autonomic function. In order to further investigate the impact of AD and the therapeutic potential of treatment of AD in patients with advanced cancer, the validity of alternative novel methods of assessing autonomic function must be appraised.
少数几项关于晚期癌症患者自主功能的研究结果表明，自主功能障碍（AD）很常见。在其他特定疾病群体中，AD 与生存率降低、跌倒以及体位性低血压、恶心、早饱和疲劳等症状有关。AD 对晚期癌症患者症状的影响尚不清楚。
我们进行了一项前瞻性队列研究，旨在确定晚期癌症患者跌倒的危险因素。连续收治于姑息治疗服务的成年门诊患者被邀请参加。参与者在基线时接受评估，包括自主功能的标准临床测试、症状严重程度评估、肌肉力量、人体测量测量、行走速度、药物使用、合并症和人口统计学信息。在招募结束后十个月记录生存信息。使用单变量和多变量逻辑回归分析检查 Ewing 分类定义的 AD 的临床相关性。使用 Kaplan-Meier 图和对数秩检验进行生存分析。
在 185 名入组患者中，45%的患者无法完成所有自主功能的临床测试。无法完成测试与脆弱性的临床指标评分高有关。能够准确地将 138/185（74.6%）名参与者分为正常、早期或非典型 AD 或明确或严重 AD：110（80%）名患者有明确/严重 AD。在逻辑回归分析中，年龄（OR = 1.07[95%CI;1.03-1.1]P = 0.001）和疲劳严重程度增加（OR = 1.26[95%CI;1.05-1.5]P = 0.016）与明确/严重 AD 相关。在调整年龄后，明确/严重 AD 患者的中位生存时间短于正常/早期/非典型分类患者（χ2 = 4.3，p = 0.038）。
自主功能障碍在晚期癌症患者中非常普遍，与疲劳严重程度增加和生存率降低有关。由于虚弱，多达 45%的参与者无法完成自主功能的标准临床测试。为了进一步研究 AD 的影响以及治疗 AD 在晚期癌症患者中的治疗潜力，必须评估替代评估自主功能的新方法的有效性。
